Treatment of single brain metastases

Brain metastases (BrM) occur in 30% to 50% of patients with malignant tumours and represent a relevant cause of morbidity and mortality. As documented by the extensive clinical use of magnetic resonance imaging with contrast enhancement, 25% to 35% of patients with BrM have a single localisation to the brain. Conventional therapeutic options for single BrM consist of either neurosurgery, or whole brain irradiation, or a combination of both. Treatment finality for the majority of the patients is palliation and life expectancy is in the order of a few months. In the last decade, the development of radiosurgery has represented an important advancement in the treatment of patients with BrM. This radiotherapeutic technique represents a possible non-invasive alternative to surgical exeresis for patients with lesions <3 cm, without a cystic component or obstructive hydrocephalus. Randomised clinical trials are warranted to define the appropriate indications and combinations of radiosurgery, neurosurgery, whole brain irradiation, and systemic treatment as well as the impact of different treatment modalities on amelioration of survival and quality of life.